| Square One Gjm | |
|
49 Olive St Gallipolis OH 45631-1632 | |
| (740) 441-5809 | |
| Not Available |
| Full Name | Square One Gjm |
|---|---|
| Speciality | Counselor - Professional |
| Location | 49 Olive St, Gallipolis, Ohio |
| Authorized Official Name and Position | Amy N Sisson (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7404415809 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Square One Gjm Po Box 272 Gallipolis OH 45631-0272 Ph: (740) 441-5809 | Square One Gjm 49 Olive St Gallipolis OH 45631-1632 Ph: (740) 441-5809 |
| NPI Number | 1982323358 |
|---|---|
| Provider Enumeration Date | 08/26/2022 |
| Last Update Date | 12/29/2022 |
| Certification Date | 12/29/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982323358 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
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